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General NPI Number Information
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NPI Number | 1336287788
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Entity Type | Individual
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Provider Name | LARRY D HAISCH D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 02/01/2007
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Last Update Date | 03/29/2016
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Provider Practice Location Address
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Address Line | 15TH AND U STREET UNIVERSITY HEALTH CENTER DENTAL OFFICE
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City | LINCOLN
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State | NE
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Zip | 68588-0618
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Country | US
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Telephone | 402-472-7495
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Fax |
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Provider Business Mailing Address
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Address Line | 9420 WILDFIRE RD
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City | LINCOLN
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State | NE
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Zip | 68512-9391
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Country | US
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Telephone | 402-328-3421
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 3859
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License Number State | NE
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